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Invited Commentary | Less Is More

Patient Perception of Benefits and Harms The Achilles Heel of High-Value Care

Deborah Korenstein, MD1
[+] Author Affiliations
1American College of Physicians, Philadelphia, Pennsylvania
JAMA Intern Med. 2015;175(2):287-288. doi:10.1001/jamainternmed.2014.6744.
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Strategies to improve the US health care system have coalesced around the concept of value, defined as the balance between potential benefits and potential harms and costs of care. Quantification of benefits and harms must be informed by the best available evidence; the patient’s perspective is central to shaping the interpretation of those benefits and harms and thus is of critical importance in discussions of value. Ultimately, then, high-value care is care for which the evidence suggests maximal benefit and minimal harm in the context of a particular patient’s values and priorities. Whereas there are some interventions with clear benefits and negligible harms that are of high value for nearly all patients and some interventions with clear harms and negligible benefits that are of universally low value, most health care decisions are made either without optimal evidence or with evidence of both benefits and harms that must be balanced. For these decisions, the interplay between the evidence and patient priorities drives shared decision making and ultimately determines the value of the intervention. Patient understanding of evidence, then, is fundamental to improving care value.

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